Prospective study of 424 cases of Staphylococcus aureus bacteraemia:: determination of factors affecting incidence and mortality
Prospective study of 424 cases of Staphylococcus aureus bacteraemia:: determination of factors affecting incidence and mortality
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DOI：
10.1111/j.1444-0903.2001.00029.x
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发表时间：
2001-03-01
影响因子：
2.1
通讯作者：
Morris, AJ
中科院分区：
文献类型：
--
作者：
Hill, PC;Birch, M;Morris, AJ
背景：金黄色葡萄球菌菌血症 (SAB) 是金黄色葡萄球菌感染的常见并发症，与高死亡率相关。目的：前瞻性记录新西兰与 SAB 相关的疾病模式，并通过记录患者人口因素和临床特征，识别与不良结果相关的危险因素。方法：从 1996 年 7 月 1 日到 1997 年 12 月 31 日，对 6 名患有 SAB 的成年人进行了前瞻性研究。 三级医院。从患者记录中获得的所有信息都记录在工作表上，并传输到计算机电子表格中进行分析。结果：共有 424 名 SAB 患者。毛利人（相对风险 (RR) = 1.8，95% 置信区间 (CI) = 1.3-2.6）和太平洋岛民（RR = 4.0，95% CI = 3.1-5.3）比欧洲人后裔更有可能感染 SAB，但不会死于感染。百分之五十的病例是社区感染的。 85% 的感染源已确定：静脉导管 (31%)（主要是医院获得）和皮肤/软组织 (22%)（主要是社区获得）是最常见的病灶。 30天死亡率为19%，其中83%在两周内死亡。预后不良的危险因素包括：年龄超过 60 岁、女性（RR = 1.4，95% CI = 1.0-2.1）、糖尿病（RR = 1.5，95% CI = 1.0-2.4）、免疫抑制（RR = 1.5，95% CI = 1.0-2.4）、既往肾功能不全（RR = 1.8，95% CI = 1.0-2.4）置信区间= 1.2-2.7）、恶性肿瘤（RR = 2.2，95% CI = 1.4-3.5）、肺为来源（RR = 2.8，95% CI = 1.9-4.2）和来源不明（RR = 2.3，95% CI = 1.5-3.3）。两个多因素评分系统还准确预测了死亡率。甲氧西林耐药率较低（5%）。结论：金黄色葡萄球菌菌血症更可能发生在某些种族群体中，而死亡率与其他可识别的危险因素相关，并且死亡率仍然很高。静脉导管仍然是 SAB 最常见且最可预防的原因。
Background: Staphylococcus aureus bacteraemia (SAB) is a common complication of S. aureus infection and is associated with a high mortality.Aims: To document prospectively the pattern of ill- ness associated with SAB in New Zealand and, by recording patient demographic factors and clinical features, to identify risk factors associated with a poor outcome.Methods: From 1 July 1996 to 31 December 1997, adults with SAB were prospectively studied in six tertiary care hospitals. All information obtained from patients' records was recorded on worksheets and transferred to a computerized spreadsheet for analysis.Results: There were 424 patients with SAB. Maori (relative risk (RR) = 1.8, 95% confidence interval (CI) = 1.3-2.6) and Pacific Island people (RR = 4.0, 95% CI = 3.1-5.3) were significantly more likely than people of European descent to acquire SAB, but not to die from the infection. Fifty per cent of cases were community acquired. A source was identified for 85%: intravenous catheter (31%), primarily hospital acquired, and skin/soft tissue (22%), primarily community acquired, were the most common foci. The 30-day mortality was 19%, 83% of whom died within 2 weeks. Risk factors for a poor outcome were: increasing age above 60, female sex (RR = 1.4, 95% CI = 1.0-2.1), diabetes mellitus (RR = 1.5, 95% CI = 1.0-2.4), immunosuppression (RR = 1.5, 95% CI = 1.0-2.4), pre-existing renal impairment (RR = 1.8, 95% CI = 1.2-2.7), malignancy (RR = 2.2, 95% CI = 1.4-3.5), lung as a source (RR = 2.8, 95% CI = 1.9-4.2) and unknown source (RR = 2.3, 95% CI = 1.5-3.3). Mortality was also accurately predicted by two multifactor scoring systems. There was a low rate of methicillin resistance (5%).Conclusions: Staphylococcus aureus bacteraemia is more likely to occur in certain ethnic groups, while mortality is associated with other identifiable risk factors and continues to be high. Intravenous catheters remain the most common and most preventable cause of SAB.